We help moms regain their confidence by getting rid of sagginess, wrinkles, and stubborn fat using surgery, laser, Botox and fillers.

Monthly Archives: April 2015

Tabloid magazines love to show “shocking” photos of supermodels and celebrities with cellulite showing, as if cellulite is some ashaming indictation they’re overweight. Well guess what? Cellulite is actually completely normal, and is not a sign of being overweight. Babies have cellulite! (although I fully admit those dimples are much more adorable on my 1 year old son’s thighs than on mine). So what causes cellulite?

Strands of connective tissue called septae tether the skin to the deeper layers of tissue. Fat pushes up between these septae, similar to stuffing pushing up against the buttons on an upholstered chair. Compare the two images below to see what I mean.

www.potterybarn.com

Now that you understand what causes cellulite, we’ll explain which treatments work. Cellulite may be more severe if you are overweight, so losing weight may help improve the appearance of cellulite. But no skin creams or non-invasive treatments have been shown to permanently improve the appearance of cellulite. Liposuction doesn’t necessarily improve cellulite, and can actually make it worse. The most effective treatment currently available passes a laser probe through a tiny incision in the skin, then uses the laser to break up the septae. This removes the little indentations where the septae tether the skin, similar to popping the buttons off that tufted chair in the photo. These treatments show some promise, but are not yet widely available.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

One of the most common questions I hear about breast reduction surgery is: “Where do I start?” If you’re at this point, the first step is a visit to your primary care physician (PCP) or Ob-gyn. He or she will evaluate your symptoms to see if they might be caused by large breasts, as well as ensure you are healthy enough to have surgery. The next step is seeing a Board-Certified plastic surgeon for an evaluation. This evalation will consist of several parts:

History of symptoms and the treatments you have tried. Insurance companies will only cover breast reduction if it is medically necessary. They require that you have symptoms caused by large breasts (e.g. neck pain, back pain, rashes under the breasts) that have not improved with non-surgical treatement. These non-surgical treatments might include physical therapy, ice or hot packs, wearing a sports bra, or even losing weight. This is why that first visit to your PCP or Ob is so important; it starts the process of documentation necessary to obtain insurance approval.

Basic health history. Some conditions, including diabetes and smoking, increase the risks of complications during breast reduction surgery. Your plastic surgeon will take a full health history to look for any medical issues.

Physical exam. The second part of obtaining insurance approval is being able to remove enough tissue. Your plastic surgeon will estimate how much tissue he or she can remove during surgery, and submit this number along with the request for preapproval. Photos will also be taken to send to the insurance company.

After your evaluation, your surgeon will gather together any supporting evidence. This will include notes from your PCP or Ob, as well as evaluations by any chiropracters or physical therapists you may have seen. This information will then be submitted to your insurance company. There are a couple special circumstances that may come in to play at this point in the process.

We find out your insurance company does not cover breast reductions- i.e. they are an excluded procedure. Some insurance companies do not cover breast reduction for any reason, even if it is medically necessary. For this reason, I recommend making a phone call to your insurance company before you see a plastic surgeon to confirm breast reduction is covered under your policy.

You have Medicare. Medicare does not allow physicians to obtain preapproval for surgery. Instead, the surgeon does the operation if he or she thinks it is medically necessary, and then Medicare decides whether or not to pay. Thus if you have Medicare, your surgeon may have you sign a document stating that you are responsible for any charges or fees if Medicare does not cover your care. Make sure you know how much these charges or fees might be before you sign anything.

If neither of the above apply, then your insurance will either approve surgery or not. It usually takes 2-4 weeks to hear back from insurance after the request for approval has been submitted.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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Television commercials would have us believe that younger skin is only a jar or bottle away. But do any of these wrinkle creams actually work?

There are only two products that I’m aware of that actually make wrinkles softer.The first is Tretinoin, also known as Retin A. Tretinoin is available by prescription or through a doctor’s office. Many Plastic Surgeons and Dermatologists actually carry it in stock, so you may not even need an appointment. Tretinoin increases collagen turnover, and over time will soften wrinkles and even out skin pigmentation. It is very irritating to skin, however, so you have to start using it very gradually. I recommend starting with the lowest strength, 0.05%. Apply a pea-size amount to clean skin at night starting Monday, Wednesday and Friday only. You may notice some dryness and redness at first. As your skin adjusts, you can increase the days you use Tretinoin until you are using it every day.

The other product that can improve the appearance of wrinkles is called TNS Serum, and it’s made by Skin Medica. This product has growth factors, retinoids, and peptides, and it’s very effective without being irritating. TNS Serum is applied morning and night. Both products take several weeks to see a difference, but they are more effective than anything available in the drug store or at the makeup counter.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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Skin bleaching creams have been around for decades, both over the counter and by prescription. Melanin is the pigment which gives skin its color, and skin bleaching creams work by decreasing the producting of melanin. The most common ingredient in skin bleaching or lightening creams is hydroquinone.

Hydroquinone falls under the category of medications considered Generally Recognized as Safe and Effective (GRASE) by the FDA. This category contains medications that have been in use since before the formation of the FDA (e.g. aspirin). These medications did not undergo the same rigorous clinical trials demonstrating safety and effectiveness that are required for new medications to be approved. In 2006, the FDA proposed that more research be done to determine the safety of hydroquinone because of two possible safety concerns:

There is some evidence that hydroquinone could be a carcinogen. Studies done on rats and mice fed the animals large amounts of hydroquinone orally, and demonstrated increased rates of cancer. We don’t know how these studies apply to humans because hydroquinone is used in much smaller doses and is applied topically, not ingested.

Ochronosis has been reported after topical use of hydroquinone. This is a condition where the skin becomes darker over time. It is fairly rare, and seems to be more common in darker skin tones. It also seems to occur after prolonged use of hydroquinone, i.e. several years. But there are no data available on how long hydroquinone can safely be used without increasing the risk of ochronosis.

The large majority of skin lightening creams available on the market contain hydroquinone. Because of above-mentioned concerns for safety, alternative products have been developed that do not contain hydroquinone. The most popular of these products is Lytera®, a skin brightening cream released by Skin Medica in 2013. Lytera® contains a proprietary blend of ingredients that work to even skin tone and lighten pigmentation, and in one clinical study it was shown to be as effective as hydroquinone in lightening skin pigmentation.

www.skinmedica.com

Skin Medical likes to advertise Lytera® as the only FDA-approved skin lightener shown to be as effective as hydroquinone. This statement is factually correct, but slightly misleading. Lytera® is FDA-approved as an over-the-counter (OTC) medication. OTC medications do not undergo the same stringent FDA-approval process as prescription medications. Instead, OTC medications are approved automatically as long as all of the ingredients they contain are already FDA-approved. The ingredients contained in Lytera® are listed on the website, and all of the key ingredients listed have previously been used in other OTC medications. So yes, Lytera® is FDA-approved. And yes, at least one clinical study has shown it to be as effective as hydroquinone. But that doesn’t mean it’s necessarily any safer than hydroquinone, which I will remind you is also FDA-approved.

So what’s the bottom line here? Skin lightening creams have been used for decades, and are generally recognized as safe. There is some data to suggest hydroquinone could have negative side effects, but no clinical trials in humans have ever been done. Non-hydroquinone products such as Lytera® are also available, but no proof exists that they are either more or less safe than hydroquinone. In the face of little data, you’ll just have to rely on your own judgement.

What do you think about hydroquinone- are you worried about negative side effects, or are you on the fence until we have more data?

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

IPL, BBL and fotofacial (or photo facial) are terms that you might hear without really understanding what they are. Today’s post will clarify some of that confusion. Let’s start by explaining the difference between laser treatment and IPL. They are often confused for one another, but they are actually quite different.

IPL stands for intense pulsed light. It may also be known under the name BBL, which stands for broad band light. IPL is a little bit different from a laser. Whereas a laser only produces a single wavelength of light, IPL uses a very bright light in all visible wavelengths (see image below).

Photo credit: http://blasononline.blogspot.com/

Different filters are then applied to filter out the wavelength of light used for a particular treatment, e.g. 515 nm to treat pigmentation, or 560 nm to treat spider veins. This flexibility allows us to use IPL to treat a wide range of clinical conditions. A photo facial (or fotofacial) is simply a particular type of IPL treatment. A conventional IPL treatment has a single target for improvement, e.g. pigmentation. A fotofacial, in contrast, treats a wide range of conditions including age spots, redness, spider veins, and wrinkles. This is done by making several passes over the skin using the different filters required. It’s a little more time-intensive than a conventional IPL treatment, and thus costs a little bit more. But because it improves the skin in so many different ways, the fotofacial is one of my favorite treatments.

Fotofacials are initially done as a series. I usually recommend 3-5 treatments 6 weeks apart. The end result is more even pigmentation and skin tone. When fotofacials are done annually, they help maintain this even skin tone, and actually help prevent wrinkles and fine lines as well. A 10 year study was done at Stanford showing that this treatment regimen actually resulted in younger looking skin at the end of the 10 year study than at the beginning!

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.